Step Forward with Dr. Szilagyi
The AAP masterfully and simultaneously works on multiple agendas on behalf of children and pediatricians. If elected, there are three critical areas that I would like to focus on.
Promote Resilience and Improved Outcomes for Children, Families and Pediatricians
I am committed to further developing and expanding the work in resilience promotion and trauma-informed care in partnership with the AAP, its chapters, the Academic Pediatric Association and training programs around the country to improve trajectories and outcomes for children and families. This includes promoting trauma-informed systems of care to promote physician and staff wellness.
Trauma-informed care cannot occur in isolation. It must be delivered in systems that are themselves trauma-informed and resilience-promoting. Fully 48% of pediatricians and pediatric trainees have symptoms of burn-out. This is neither acceptable nor sustainable. Many of us also experience secondary traumatic stress related to witnessing the suffering of children and families. But, we can use the science of resilience and the affiliate response to build systems of care that include psychologically safe work environments, reflective supervision, and that support our relationships with each other and with the families we serve. This is very the essence of the team care that is crucial to professional wellness and well-being.
Enrich Our Advocacy Efforts on Behalf of All Children
Advocacy has been integral to all of my work and I will work diligently and collaboratively with the AAP and its leadership, staff and members on advocacy. While my particular expertise is in vulnerable and underserved children, I am committed to partnering with others to enrich our advocacy efforts on behalf of all children. In addition to pushing forward on the implementation of major child welfare legislation known as Family First, I plan to work on climate change. The science is in. The signs are all around us. Time is running out. There is a phrase in Judaism, “tikun olam”. It quite literally means “to repair the world”. I have a personal stake in this. We lost our home in November 2018 in the Woolsey fire in CA and my home country of Australia burned for three months. More importantly, I have grandchildren and patients who will inherit this world.
Despite the trauma, ACEs, and stressors experienced by children, despite the multitude of threats facing pediatricians, despite the burnout experienced by some, I am optimistic that the future is bright for children and our profession. And my optimism rests with the AAP and the creativity and passion of our members from trainees to seniors. The AAP is an amazing institution and I am so proud that it has been and is my professional home.
Leverage Data to Justify Adequate and Fair Compensation
I vow to work with the AAP leadership on utilizing data to justify payment for the good work we do and leveraging technology to improve and inform care. This includes payment for the great work pediatricians do on prevention, including immunizations, developmental and mental health screening, and anticipatory guidance. And, it also includes payment for trauma-informed care and resilience promotion, care that our children and families need now to improve their health and well-being trajectories—and care that has the potential to save payers immense costs down the line. Pediatricians also need payment for chronic disease management. Study after study shows that care coordination, strong linkages between primary care and pediatric subspecialists, involvement of skilled staff in a variety of disciplines result in: a) improved quality of care and outcomes for children and families, and b) reduced hospitalizations and reduced total medical costs.
As health care undergoes massive transformation, pediatricians face a multitude of simultaneous pressures on a daily basis. We are all doing more and more without adequate payment or resources, making work sometimes feel more burdensome than joyful. As Chief of a division at UCLA that includes primary care and sub-specialists, I deal daily with the challenges of maintaining high-quality compassionate care in a climate of slim financial margins where access is mediated by insurance coverage rather than by the patient’s health needs. Inequities in insurance coverage promote inequities in access to healthcare, especially to care coordination and mental health care. The AAP is a leader in using data in advocating for equitable access and fair payment and moving us toward universal coverage.
Pediatric Medical and Surgical Subspecialists
Pediatric Medical and Surgical Subspecialists encounter a number of challenges. Subspecialists are dealing with workforce shortages in almost every subspecialty, the administrative burdens related to EMR documentation, and navigating variable and complex insurance processes, all leading to high levels of burn-out. The advances in subspecialty care mean that more children survive with medically complex conditions but may not have access to the subspecialty care they need when they need it.
Navigating Insurance Processes: Subspecialists rely on referrals from primary care and prior authorizations for those referrals, which insurance companies sometimes decline. An active patient may need prior authorization for a specific medication or intervention from the sub specialist. In either case, navigating the processes of different insurers becomes an additional time-consuming burden.
Payment at Parity: As is true of pediatrics in general, pediatric subspecialists are paid below parity with their counterparts in adult healthcare, often for providing a very similar service. Moving forward, we need to advocate for parity of pediatric subspecialty reimbursement with adult subspecialty care, and a more cohesive and stream-lined prior authorization process. During COVID-19, many subspecialists have adopted and adapted tele-health to manage all but their most complex patients; many would like to continue this service but payment would have to be at parity with in-person visits.
Stream-line Board Certification: As the American Board of Pediatrics moves to a choice between a proctored exam (MOC Part 3) and the newer Maintenance of Certification Assessment (MOCA-Peds), the transition for some subspecialties will leave subspecialists with upcoming certification lapse dates having to take the proctored exam. Creating an alternative structure (using accrued CME credits etc.) to maintain certification during the transition period would enable affected subspecialists to defer until MOCA-Peds becomes available in their field.